November 2007 – Page 11

November 8, 2007

4 Years Ago, Doctors Said We Were 10 Years From a Hair Loss Cure – Hair Loss Information by Dr. William Rassman

3 or 4 years ago I found myself attending lectures on hair loss. The belief at the time, was that any sort of “CURE” for hair loss was approximately 10 years away. The same answer was given by several doctors. Now I completely understand that a cure will only come when it comes and that a doctor telling me that a cure is 10 years away, does not mean that I should set a timer and count the seconds, but I’m curious if science and technology supports that response? Has our knowledge and science progressed enough that a cure could be,….7 or 8 years away? or are doctors still saying 10?

It seems 10 years is a good round number and far enough away that we can promise these cures and just let the timeline slip. In reality, nobody really knows. I do not think anything significant has happened in the last 2 or three years to say the “cure” is 7 to 8 years away.

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November 8, 2007

2 Weeks After Starting Finasteride, A Bald Spot Appears – Hair Loss Information by Dr. William Rassman

I am a 47 year old male who has been using rogaine for 4 years to “contain” male pattern thinning. I recently started taking finasteride to see if that would help more. I started taking 2.5 ( 1/2 of the 5mg pills) for a couple of weeks and have noticed a small but very noticeable bald spot develpoing at the very front of my hairline! ( it was always thick there) Is is possible that the finasteride could cause this? I have started to cut the pills into quarters as it seems like 1mg daily is the recommended dosage. Should I stop the finasteride? I am about to start taking synthroid as my T-4 totals are a bit low and I know that the thyroid can cause hair loss but I think it has something to do with the finasteride.

The recommended dose of finasteride for the treatment of male pattern baldness (MPB) is 1mg orally each day. Taking more will not have a greater benefit. I doubt that taking 2.5mg a day has caused you to lose hair on the front and I would not recommend stopping the medication without discussing these issues with the doctor who prescribed you the medication. There may be other causes of hair loss that you are not aware of and your doctor will be able assess this as he/she is able to physically examine you.

November 7, 2007

Small FUE Procedures Every Couple Weeks – A New Marketing Gimmick or a Reality? – Hair Loss Information – Balding Blog

A patient came to see me last week asking about multiple, short Follicular Unit Extraction (FUE) procedures for his frontal hairline, eventually totaling 1400 grafts. He is a busy attorney and wants to have his hairline restored, but did not have the time to get it done. He went to a doctor who told him that he could come in after court every 2-3 weeks, and get 200 FUE grafts placed into the frontal hairline. As an attorney who does not trust anyone at first glance, he came to me for a second opinion. Money was not an issue, but the charge would be $2,000 for each procedure.

I told him that this did not seem like a good idea to me. If he had 1400 grafts total over 7 sessions just two-three weeks apart, the hair would fall out between the surgeries and the surgeon could not see where the previous transplants were placed, therefore possibly causing damage. I also believe that 7 surgeries are not as good as one, but if he insisted on multiple surgeries, he must wait 7-8 months between the surgeries so that the previous grafts would not be damaged. It is possible that two surgeries spaced 2-3 weeks apart (one on the right side and one on the left side) might be able to harvest 500-700 grafts through an FUE surgery, but he would have to keep his hair long.

For more on FUE / FOX Procedure, please see:

November 7, 2007

Traction Alopecia… From Masturbating? – Hair Loss Information by Dr. William Rassman

I seem to look at pornography a lot and masturbate. As a result I’ve experienced hair loss around my thighs. What are some ways to regrow that hair and how long does it take to regrow?

I am sure that there are may ways to masturbate, but I have no idea what in the world you would be doing to cause traction alopecia on your thighs. Am I asking the right question here?

If you are particularly bothered by hair loss on your thighs you can try Rogaine (minoxidil), which may help. Transplants should be your last step and assuming that you have traction alopecia, you should stop (or alter) the action that is rubbing on your thighs.

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November 7, 2007

Punch Biopsy to Help Determine Cause of Female Hair Loss? – Hair Loss Information by Dr. William Rassman

23 y/o female
All over hair loss for about 1 year.

I saw a dermatologist about a year ago, who did nothing but refer me to Rogaine. I am seeing a new doctor who suggested some hormone tests (all blood results came back normal last year) for FSH and a male hormone (she did not specify which). She then said “there is likely nothing we can do, but at least we’ll know the cause”. I am quite nervous about this, as I don’t wish to go through all the testing if there is nothing that can be done, and also because I have heard that with a punch biopsy hair must be shaved and hair will not regrow. She wants to do 2. Is it worth having this done? I am already losing enough hair and certainly do not want to voluntarily get rid of more…

Punch biopsy Hair loss in women is a difficult problem, because most of the time there is no medical cure. Even if you correct the “curable” causes of hair loss, such as low iron levels or thyroid problems, it does NOT necessarily mean your hair will grow back. I suspect this is due to genetic causes, but women’s hair loss is different from men’s hair loss. Medications such as Propecia are not approved by the FDA (even if it were approved it may not work). Hair transplantation for women is also limited, because women’s’ hair loss is generally diffuse and there is no good “donor” hair area as there is in men.

Thus, often times doctors are left when a desperate female patient coming to them with hair loss and it is often times our reflex to order blood tests and biopsies to find the “problem”. Some conditions do show up on a biopsy, some of them are expressions of genetic female balding, and sometimes autoimmune type diseases like diffuse alopecia areata. Unless your hair loss is due to major medical problems, there are very few medical options available to you and Rogaine (minoxidil) is generally the main modality of treatment. When used as directed, the Rogaine works well in a small majority of women, and mildly in a larger proportion of women. Some doctors may offer a variety of steroid shots or other hormone altering regimen, but none of these methods have been universally accepted to work. The use of spironolactone injections have been discussed on this site before.

If you are losing hair and you need to know why, you can consider a punch biopsy. This is a question you need to address with your doctor, of course, as you weigh the risks versus the benefits. Your doctor should be able to tell you why there is a need for the biopsy and what he/she is expecting to see.

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November 7, 2007

Doctor Froze Bumps on My Scalp — Now I Have Even More Bumps! – Hair Loss Information by Dr. William Rassman

Hello,

I am 54 years old and recently found bumps all over my scalp. I went to my dermatologist and before I could say a word she “froze” the bumps! I was in such shock and pain that I couldn’t move and when I got home, the bumps were much bigger, swollen and scabby. I started to use the shampoo she prescribed as well and it got a little better, but now I have twice the amount of bumps I had then before! Please help! I don’t want these bumps on my head and I’m afraid of going to another dermatologist. Just for some past reference, I do dye my hair and have been doing so for the past 25 years. Can this be something that is causing the bumps now? I really appreciate your help with this.

I honestly don’t know how to help you. I take the view that the doctor works for you, so if the doctor does not satisfy your medical needs, you “fire” the doctor and “hire” another. I don’t know what the bumps are or what could be causing them. You need to see a doctor who takes the time to bond with you. Unfortunately, I can’t provide more help without examining you.

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November 7, 2007

Blocking 100% of DHT? – Hair Loss Information by Dr. William Rassman

Hi Doc,

I have asked you several questions in the past, all of which you have given me very good responses, I am very grateful for that.

This is just a speculative question; If 100% of DHT was to be blocked do you believe the number of patients growing hair would drastically improved.

Blocking 100% of DHT is seen in those individuals who are born with 5 alpha-reductase deficiency and there is no balding in these men. Androgenic alopecia (AGA), otherwise known as male pattern baldness (MPB), is genetic… and genetic predisposition will always win with any DHT production.

Castration is a radical way to block DHT formation by removing the major testosterone influence and we know that there is some androgen hormone production from other than the testicles (we do see women with androgenic influences on their genetic hair loss in some situations). I suspect, however, that a 100% block of DHT would stop the hair loss at whatever stage it is in, but not reverse what had already happened.

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November 7, 2007

Any Antidepressant Drugs Without Hair Loss Side Effects? – Hair Loss Information by Dr. William Rassman

Hi Doc,

I was wondering if you know of any antidepressant drugs that do not have hair loss as a side effect. I have severe OCD and depression but I know if I was to take a medication and loose my hair I would be devastated. I was thinking about wellbutrin and did pick up a prescription for it but I am nervous about what it will do to the thickness of my hair sense I have always had thin hair to begin with. Your website has been very helpful and admire your work so any feedback you might have for me on this issue will be greatly appreciated.

Antidepressant medications do not necessarily cause hair loss, but it is a known side effect in a small number of patients. The most common cause of hair loss in men is genetic. Any changes in medications and its potential side effects should be discussed with your doctor.

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November 6, 2007

Hair Loss InformationChest Pain, Indigestion, and Outpatient Surgery – Hair Loss Information – Balding Blog

Heart Yesterday, I received some sad news when I learned about the passing of one of our hair transplant patients just 5 months after his procedure. He had complained to his local doctor about chest pain and was told that it just was indigestion. This patient complained a number of times about the chest pain to his physician and each time he was tagged with the diagnosis of reflux. He recently had a heart attack and died.

Although the outcome was different, this reminded me of a similar case that I wanted to share. A female hair transplant patient had complained of periodic chest pain when I took her medical history. It sounded like cardiac pain (angina), so I had her see her doctor. He took an electrocardiogram (ECG — also known as an EKG) and told her that the pain was reflux (stomach type pain), not heart pain. She came back to me for a hair transplant, but I did not like her doctor’s diagnosis since it sounded like classic angina (pain coming on with exertion, climbing stairs, and fast paced walking), so I sent her back to her doctor. Again, he reassured her that the pain was not cardiac in nature, as her ECG was normal. I then got into her medical care and called her doctor, suggesting that he perform a stress ECG. He told me that it was unnecessary and again insisted that the pain was not cardiac. This lady wanted a hair transplant and was unable to persuade her doctor to get further testing, so because her doctor had cleared her and she wanted to proceed, I transplanted her.

During the surgery, she began experiencing chest pain, which I then treated with nitroglycerin, fortunately relieving her discomfort. This happened twice during the procedure. After surgery, I called her doctor and told him of the events at surgery. He saw her again after the transplant procedure and told her that she did not have cardiac pain and was upset with me for interfering with his medical care of her. I suggested to her that she see another doctor for a second opinion, but she liked her doctor and wanted to stay with his opinion. Three weeks after the surgery, she had a heart attack, and fortunately for her, she survived.

Being right is not a consolation from my point of view. We know from the anesthesia literature, that for people with heart disease and outpatient surgery, the risk of a heart attack in the 30 days after the surgery is higher than in the average person without surgery. Undergoing any surgery is no small matter and although I have never experienced any cardiac problems with my patients that I could not manage in surgery, risk clearance for anyone over the age of 45 years old, a good and thorough physical examination should be a medically necessity. We must all be on guard for detecting heart disease early and there are many good ways to do this today. The sad reality, however, is that in nearly 50% of cases, the first sign of heart disease is death.

November 6, 2007

So Much Hair in My Brush Every Time — Is It Cancer? – Hair Loss Information by Dr. William Rassman

I’m constantly losing hair and i’m getting worried…i’m 15 (female) and my hair lose has just got worse and worse…my hairs are everywhere around the house and even when i’m not brushing it i can still see strands and strand of hair dangelling and then when i do brush my hair my brush is completely full of hair after 2minutes of brushing it…i dont over brush my hair or underbrush it but theres a history of cancer in my family…my mum had cancer and my dads currently got cancer…could this be a sign of cancer?

This is most certainly not a sign of cancer. Normal people lose 100-150 hairs per day (not necessarily all on the brush, but throughout the course of a day). Some people obsessively count the hairs that come out, but if you are truly concerned, see a dermatologist or hair specialist.